Unique barriers to care and outcomes of pediatric acute lymphoblastic
leukemia treatment in the Gaza Strip
Abstract
Background: Childhood acute lymphoblastic leukemia (ALL) is the most
common pediatric cancer worldwide. Although children in high-income
countries enjoy survival rates of approximately 90%, children in
countries with limited resources suffer from survival rates of less than
35%. No published data on pediatric cancer incidence, management, or
outcomes in the Gaza Strip are available. Methods: A retrospective
cohort study was undertaken for pediatric ALL diagnoses admitted to the
only pediatric cancer ward in the Gaza Strip between 2010 and 2015.
Outcomes included Event-free survival (EFS) and overall survival (OS)
calculated by Kaplan–Meier estimates. Events were defined as induction
failure, relapse, and death. Results: The 3-year EFS estimate was 80%
(95% confidence interval [CI], 66%–89%) (Figure 1). The EFS at 1
and 3 years for high-risk ALL was 55% (95% CI, 27%–76%) and 23%
(95% CI, 4%–51%), respectively (Figure 1). The 3-year OS was 93%
(95% CI, 82%–97%) (Figure 2). The 3-year OS for high-risk ALL was
69% (95% CI, 30%–90%). All 84 (100%) patients required referral to
an OSH for definitive ALL diagnoses and induction therapy. Forty-four
(52%) patients required at least one additional referral. Conclusions:
The overall outcomes demonstrated relatively high survival rates at 3
years which may be artificially elevated due to exclusion of
adolescents, limited follow up, and deceased patient charts unavailable.
Structural determinants of health in Gaza lead to limited diagnostic and
treatment capabilities, advanced medical training, and reliance on
out-of-territory transfers for care. These barriers impact the access to
comprehensive pediatric care in Gaza.